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Currently, we are facing a situation where many people in the world are suffering from kidney-related diseases. In fact, according to the National Kidney Foundation, at least 10% of the global population suffers from chronic kidney disease, and at least two million people receive dialysis treatment nowadays. Sadly, most of the patients who actually have access to dialysis treatment are those who live in developed countries. Those who live in developing countries not always have access to the treatment, and when they do it is often unsatisfying.

It is not a secret that for those patients who have end stage renal disease or ESRD, dialysis becomes the only alternative to survive before actually thinking about getting a kidney transplant. However, if you are living in a developing country and don’t have the resources to pay for private treatment, your chances of being properly treated can run really low.

Poverty, ignorance and the lack of medical resources are some of the most common elements that affect the possibilities patients have to access dialysis. Even sometimes, when patients have the chance to pay for a better treatment, this is not available in their region and there is little or nothing they can do about it once they are sick.

So, why all this happens? In this article, we will explore the main factors related to the way dialysis treatment takes place in developing countries. All this keeping in mind that many of the patients who need dialysis in these countries actually don’t know about it. This happens either because they cannot afford to go to the doctor, their healthcare systems are also poor, their records are not properly kept, or simply because they lack the will or intention to go to the doctor under these unpleasant circumstances.

Let’s take a look to some of the most important issues that affect the way patients who need dialysis treatment are actually treated in developing countries.

High costs

This is the most obvious and common factor related to many things that don’t operate properly in developing countries. When it comes to treating ESRD patients, healthcare providers face a critical situation because their ethics tells them they should treat the patients properly. However, the financial capacity keeps them away from actually doing so.

Setting and running a dialysis unit is rather expensive. Even though every country in the world has patients with kidney disease among its population, not many institutions have the needed resources to start a dialysis unit. Besides, when these dialysis units are actually set, they will need to keep on growing and being properly maintained. This also implies expenses related to the unit’s operation that many institutions can’t afford.

Machine problems

Let’s say that the dialysis unit was created. All the machines in it will need to be properly taken care of in order for it to be sustainable. Most times, the machines that are kept in good shape remain in the cities, where technicians and medical equipment companies are located at. This leaves the poorest areas of developing countries aside. Therefore, people who live in the areas (which also happen to be the poorest) has little or no chances to access the dialysis services.

Another problem related to dialysis machines is that they are not always enough to treat all the patients. In addition, the available machines are not often functioning and present multiple problems like breakdowns, missing parts, or obsolete systems. All this is being considered also keeping in mind that in some low-income areas power can also be off.

Staff problems

Problems related to machines are not the only ones to come. We also need to keep in mind that in order to use one of these dialysis machines, we need to count on the help of a prepared staff member, who knows how to use the machine.

Here we face bigger problems because sometimes there are not properly educated individuals who know how to operate the dialysis machines and when there are, wages are usually not enough for them to make a living out of it.

All this crisis happens because many of the dialysis units depend on the state. Public hospitals and public health care facilities are often poorly financed in developing countries, which makes it hard for the ideal staff to work at these places and operate dialysis units. As a consequence of this, many units need to close because they don’t have the required staff to work at them, and once they are restructured, they can be opened again.

It is important to keep in mind, that matter how poor a country is, the motivation of people to work is usually directly related to the amount of money that is being paid to them. If there are no resources to cover up for the staff expenses, then there won’t be enough or well-prepared people to work at dialysis units.

In the United States at least 217,000 patients need to live with dialysis. This represents national costs for over $11 billion dollars every year. This procedure needs to take place when the kidneys are unable to filter fluids and their full capacity is lost. Sometimes, patients who need to live with dialysis have to do so because they were born with a kidney condition and they cannot afford a kidney transplant.

Statistically speaking, this is a dramatic situation for thousands of people in the United States. However, most patients seem to believe that dialysis is not such a terrible thing and they have adapted to a “new normal life”. But, what does it means to live with dialysis? In this article, Joe Cosgrove will share some details related to the way patients learn to have regular lives while they depend on dialysis to survive.

The Experience

First of all, when a patient decides that it is time to go under dialysis treatment it is because its kidneys are not able to do their job. This means that dialysis becomes the only alternative to survive. Keeping this in mind makes it easier and more motivating to people who need to go under treatment.

During a regular dialysis routine, the patient needs to come to the dialysis clinic and meet the nurse at the counter. Papers and forms will be filled out and a short checkup will take place. Since most patients have done this a thousand times, the process usually doesn’t take long.

After the checkup, the patient settles into one of the comfortable recliners inside the room where the process usually takes place. The patient may be the only one in the room or not, depending on the day and time it decides to go and get the treatment.

After settling, the patient will need to prop its left arm, allowing the technician to slip a couple needles into its blood vessels (close to the wrist). One of the needles is in charge of removing the blood and the other one is in charge of taking it back to the body. These needles are attached to plastic tubes that at the same time are connected to the dialysis machine.

For the next three hours, the needles will do their job and the patient’s blood will be filtered. All this is possible thanks to the dialysis machine that stands still next to the patient’s recliner. Most patients bring a book or spend this time watching a movie or a TV show on Netflix. Sometimes, this is even the perfect moment to take a nap.

Besides from the initial moment of the procedure, when the needles need to be stuck on your veins, the dialysis process doesn’t hurt. Sometimes patients may feel dazed and their blood pressure can drop. But, other than that, the process takes place in a comfortable way.

Living with dialysis is supposed to make things easier for patients with End Stage Renal Disease (ESRD). However, the mortality rates in the United States remain to be considerably high compared to those in Japan or Europe since many patients choose to skip the procedure or don’t accept it to last for too many hours.

How Dialysis Works

The best way to describe the dialysis process is as an artificial kidney. This means that dialysis should be able to do what your kidneys cannot do anymore. There are two different forms of dialysis: hemodialysis and peritoneal dialysis. At least 90% of the patients in the United States who live with dialysis choose to go under the hemodialysis treatment. This is the procedure that was described in the experience above.

When patients live with hemodialysis, their blood needs to be circulated outside of the body with the help of a hemodialysis device. This device cleanses the blood and then returns it back to the body of the patient.

Not everyone is a right candidate to get hemodialysis. This is why every patient needs to have the doctor’s approval before having an entrance or access (a minor surgery on the leg, arm or neck to access the blood vessels). This access is called fistula and the patient will need to keep it clean and usable for as long as it needs to go under dialysis treatment.

The fistula is something dialysis patients need to learn how to live with since it is the only way doctors have to access the blood in a fast and effective way. Fistulas are joints between arteries and veins located under the skin that form a larger vessel where needles are inserted.

When patients don’t need to live with dialysis and only go under a temporary treatment, they can get a catheter on their neck and there is no need for them to go under this minor surgery. In the case of the fistula, the wound needs to heal before the dialysis treatment takes place. However, in case patients use a catheter, they can go under the dialysis treatment right away and the procedure is slightly different.

As Joe Cosgrove has already pointed out in previous articles, having kidney disease means that your kidneys are not properly working and are not able to filter blood anymore like they should. When this condition gets worst it is known as end-stage renal disease or ESRD and needs to be treated with dialysis.

Most people think that ESRD only affects adults since their bodies are more deteriorated. However, ESRD also affects children. At least 1,462 children in the United States need to start dialysis treatment every year. Most of these children have congenital disorders (33%), have damaged kidneys due to glomerular disease (24,6%), or need to go on dialysis because they have glomerulonephritis (12,9%).

When we talk about adults, the most common causes of kidney failure are related to high blood pressure or diabetes. Nevertheless, when we talk about children, kidney disease is rarely related to those two conditions and it is often caused as a side effect of other treatments or because they have a hereditary condition that may affect their urinary tract.

Treating Children with ESRD in the United States

Every year over 10,000 children is treated for ESRD in the United States. Most of these children use hemodialysis as it is less invasive and easier to adapt to their bodies. This is how, every year 56 percent of these children are treated with hemodialysis and the rest just go under peritoneal dialysis, have kidney transplants or take alternative treatments.

At least 1,300 children are listed for kidney transplant every year. Over the past 20 years, this number seems to have grown dramatically since kidney diseases have become more popular among the U.S. population.

This is how treatments and medical procedures for children have also evolved. Technology has done major improvements and filtering membranes and catheters are now meant to be used in children, so their size is smaller, sometimes they are more resistant and flexible.

At first, there were many side effects related to hemodialysis in children. However, this seems to have been controlled over the past two decades. Now the morbidity rates during dialysis have considerably decreased and it is less common to experience seizures as a side effect during the treatment. The already mentioned medical advances have made it easier for children to deal with such an invasive procedure, so hypotensive episodes are quite uncommon nowadays.

A sensitive treatment

Two decades ago it was common for a dialysis patient to say that it was feeling pain or discomfort during the treatment. Keeping in mind that children’s bodies are more sensitive and fragile, dialysis procedures are less painful and discomforting today. The catheters used during the entire dialysis process are internal, making it impossible for children to remove it without helps. Besides, anesthetic creams are used to puncture the patient.

More sensitive and less invasive technologies have also been developed in order to reduce dramatic effects such as morbidity. These technologies can also reduce healthcare costs, making it simpler for the health care providers too.

Synthetic materials used in children are biocompatible and have a smaller size. This way, tubing and other processes related to pediatric dialysis are easier on the infant’s body. Diameter and length of tubes have been reduced so they can fit the patient’s veins. This way, the volume of filtered blood is going to be adequate both for having a successful a treatment and taking care of the child’s needs.

Machines used in pediatric dialysis are also special ones, so blood pumping is normal compared to the one that happens during the treatment adults get. Most dialysis machines used with children are designed to meet their needs and be used with pediatric patients.

The speed used when the blood is pumped in children is slower than in adults and needs to be kept that way since the capacity of patients to output blood is different and veins could be cloaked. For this reason, children need to be monitored during the entire dialysis session. Machines are always designed in a way that it is easier for healthcare providers to be in control of the dialysis process during the entire time.

Hemodialysis

Since children with ESRD will need to be exposed to dialysis for a long period, hemodialysis needs to be seen as a whole and not as a mere step of kidney disease therapy. Dialysis in children should be seen as a temporary thing. This happens because if the patient is feeling better then it will stop the treatment and if things complicate and the kidneys completely fail, then the pediatric patient will need to get a kidney transplant.

When patients have the chance to heal, then hemodialysis enables the chances for patients to improve their condition, while they can keep having a normal life. This treatment can often affect children’s physiologically when it is done in the long term, so it is recommended to give some kind of support to children while they are going through dialysis treatment.